1. Missouri WIC Customer Satisfaction Survey: Summary Fiscal Year 2010

2. Overall Purpose of the Survey To determine how Missouri WIC can improve service for non-native English speaking participants; To determine how service needs differ between English and non-native English speaking participants; To determine how service needs differ among specific groups of non-native English speaking participants.

3. Sampling Method A language proficiency summary report was generated from the Missouri WIC Information Network System (MOWINS), which collects the language spoken by participant. 21 local WIC providers were selected to participate in the FY 2010 WIC Customer Satisfaction Survey based on the number of participants who spoke various languages.

4. Survey Instrument The FY 2006 survey instrument was developed by consultants from Sinclair School of Nursing, University of Missouri-Columbia and the MO WIC Cultural Competency Team based on research questions provided by the Cultural Competency Team. The Missouri WIC Program revised the content and format to include additional education & FI redemption questions in the FY 2008 WIC Customer Satisfaction Survey. The FY 2008 survey instrument was again used for the FY 2010 WIC Customer Satisfaction Survey.

5. Selected Local WIC Providers NWNECentralSESWEastern St. Joseph/ Buchanan SalineColumbia- Boone DunklinBarrySt. Charles TrumanCamdenHowellSpringfield- Greene St. Louis HDC CrescentPettisJoplinFamily Care Samuel Rodgers McDonaldGrace Hill NewtonSt. Louis County Taney

6. Language of Surveys Returned by Agency DistrictLWPArabicBosnianEnglishRussianSomaliSpanishVietnamese NWSt. Joseph/Buchanan Truman Crescent Samuel Rodgers NESaline CColumbia-Boone Camden Pettis SEDunklin Howell SWBarry Springfield-Greene Joplin McDonald Newton Taney

7. Language of Surveys Returned by Agency (continued) DistrictLWPArabicBosnianEnglishRussianSomaliSpanishVietnamese ESt. Charles St. Louis HDC Family Care Grace Hill St. Louis County

8. Distribution of Completed Surveys by Language LanguageDistributed SurveysCompleted SurveysResponse Rate English63059294.0% Spanish70053276.0% Somali1459464.8% Vietnamese856677.6% Russian655280.0% Arabic854755.2% Bosnian902932.2% Blank--11-- Total1,8001,42379.1%

9. Categories of Questions for Evaluation Application and education processes WIC staff and vendors WIC checks Favorite things and hard requirements Overall satisfaction

23. Note: The percentages in Question 14 are out of the total numbers of ELS and NELS participants.

30. Conclusions Overall, in FY 2010, both ELS* and NELS † participants were very satisfied with most aspects of the WIC program - even more were satisfied than in previous years. Both ELS and NELS participants’ three most favorite things about WIC: 1.Information on healthy eating and lifestyle 2.Checks for healthy foods 3.Checks for infant formula *English Language Surveys † Non-English Language Surveys

31. Conclusions (continued) Three hardest requirements from WIC: ELS participants: 1.Bringing in children 2.Keeping appointments 3.Attending nutrition education sessions NELS participants: 1.Keeping appointments 2.Completing forms 3.Bringing in children

32. Conclusions (continued) Improvements are recommended if more than 20% of participants from one or more groups chose the less positive responses.

33. Conclusions (continued) > 20% of the participants who completed Bosnian, Somali and Vietnamese surveys said that the application process and health assessment process were “somewhat difficult” or “difficult”; > 20% of the participants who completed Arabic, Bosnian, Somali and Vietnamese surveys said that the nutrition assessment process was “somewhat difficult” or “difficult” and that they “sometimes” or “never” understand the words used by WIC staff;

34. Conclusions (continued) > 20% of the participants who completed Somali surveys said that the nutrition education was “somewhat helpful” or “not helpful”; > 20% of the participants who completed Bosnian, Russian, Somali, Spanish, and Vietnamese surveys said that they did not have access to the Internet;

35. Conclusions (continued) > 20% of the participants who completed Arabic, Bosnian, English, Somali, Spanish, and Vietnamese surveys said the cashiers at the WIC store or pharmacy are helpful “sometimes” or “never”; > 20% of the participants who completed Arabic, Bosnian, English, Russian, Somali, Spanish, and Vietnamese surveys said the WIC store they shop at has the WIC foods they want “sometimes” or “never”;

36. Conclusions (continued) > 20% of the participants who completed English surveys said they use all the WIC checks they are given “sometimes” or “never”.

37. Recommendations WIC Vendors: One specific program component should be investigated - WIC vendors. Although more than half of participants from both groups responded favorably to questions about WIC vendors, these proportions were much lower than those for other areas.

38. Recommendations (continued) Communication: More than 60% of the NELS participants whose first language was not English said that they “sometimes” or “always” need an interpreter. Data indicates that some participants have difficulty communicating with WIC staff and completing forms. More interpreters need to be made available to non-native English speaking participants. Educational materials that are designed to be culturally- sensitive should be provided to participants in their first language.

39. Recommendations (continued) Due to the large Spanish-speaking population served by WIC, it may be beneficial to provide brief Spanish language training on words or phrases specific to WIC. Refresher cultural competency training should be provided for local WIC providers in the metropolitan areas and other areas with pockets of non-native English speaking WIC participants.

40. Recommendations (continued) The three groups who consistently chose a less positive answer throughout the FY 2010 survey included those who completed Bosnian, Somali, and Vietnamese surveys. This indicates a possible language and/or cultural barrier that should be investigated and addressed in order for WIC to better meet the needs of these populations. It may be necessary to bring in experts to provide cultural competency trainings on these specific cultures.

41. Recommendations (continued) Nutrition Education: Local WIC providers should consider scheduling individual counseling sessions for NELS participants who prefer this method of gaining nutrition information, especially for the Somali, Bosnian, Arabic, and Vietnamese populations. Encourage local WIC providers to use alternative methods to provide nutrition education in addition to individual and group nutrition sessions. It may be beneficial to the groups above to be offered nutrition classes in their first language. Data also indicates the need to develop web-based nutrition education modules for English- speaking participants and take home nutrition education modules for both English and Non-native English speaking participants.